Fungal co-infection in COVID-19 patients: Should we be concerned?

Autores de IIS La Fe

• Javier Pemán García

  Autor

• Alba Cecilia Ruiz Gaitán

  Autor

• Miguel Salavert Lletí

  Autor

• Paula Ramírez Galleymore

  Autor

• Marta Garcia Hita

  Autor

Participantes ajenos a IIS La Fe

• García-Vidal C
• Puchades F
• Alastruey-Izquierdo A
• Quindós G

Grupos

• Infección Grave

  

  Investigador Principal

  María Ángeles Tormo Mas

• Medicina Intensiva

  Leader

  Álvaro Castellanos Ortega

Abstract

Critically ill COVID-19 patients have higher pro-inflammatory (IL-1, IL-2, IL-6, tumor necrosis alpha) and anti-inflammatory (IL-4, IL-10) cytokine levels, less CD 4 interferon-gamma expression, and fewer CD 4 and CD 8 cells. This severe clinical situation increases the risk of serious fungal infections, such as invasive pulmonary aspergillosis, invasive candidiasis or Pneumocystis jirovecii pneumonia. However, few studies have investigated fungal coinfections in this population. We describe an update on published reports on fungal coinfections and our personal experience in three Spanish hospitals. We can conclude that despite the serious disease caused by SARS-CoV-2 in many patients, the scarcity of invasive mycoses is probably due to the few bronchoscopies and necropsies performed in these patients because of the high risk in aerosol generation. However, the presence of fungal markers in clinically relevant specimens, with the exception of bronchopulmonary colonization by Candida, should make it advisable to early implement antifungal therapy.

Keywords

• Aspergillosis, Aspergilosis, COVID-19, Candidiasis, Coinfección fúngica, Fungal coinfection, Invasive mycoses, Micosis invasiva, Neumocistosis, Pneumocystosis, SARS-CoV-2